Efficacy of foot orthoses. What does the literature tell us?

Changes in gait pattern and quality of life of adolescents with flexible flat foot after Calcaneal Lengthening Osteotomy

BACKGROUND

Calcaneal Lengthening Osteotomy is a surgical technique to correct flexible flat foot deformities in patients who did not show any change in their symptoms after conservative treatment. In this study, the effects of CLO on the kinematic and kinetic changes of gait was analyzed and the clinical and quality of life improvements in children treated by CLO for moderate to severe symptomatic flexible flat foot deformities were assessed.

METHODS

Participants were seven adolescents (13 feet) with symptomatic FFF who underwent during 2019-2022 and seven (10 feet) healthy children as control group. Three items were evaluated in each foot before and after surgery including: 1. Clinical examination 2.quality of life (using Pediatric Quality of Life Inventory version 4 questionnaire) 3. Gait analysis (Vicon motion systems, Oxford metrics Inc., UK). Also, the kinetic and kinematic analysis between patients and healthy groups were compared.

RESULTS

Kinematic results of control was significantly better than FFF group. Ankle range of motion(32.94 ± 13.39 compared to 32.94 ± 13.39,P-Value:0.01),foot progression angle (-9.26 ± 7.67 compared to -16.07 ± 9.00,P-Value:0.01),and internal rotation of ankle was higher in control group compared to FFF. FFF patients demonstrated improvement in kinematic results after CLO surgery. Foot progression angle was improved after surgery (-11.31 ± 6.07 compared to -16.19 ± 7.06, P-value:0.00), maximum plantar flexion decreased after CLO surgery due to achil tendon procedure during CLO surgery. Kinetic results of FFF patients showed significant increase in ankle Power in coronal and transverse plane, Also knee and hip power showed similar results.Quality of life parameters showed significant improve in all parameters (Physical,Social, emotional and school function), Also ADKE and ADKF improved after surgery.

CONCLUSION

CLO surgery significantly improved patients' quality of life of patients with symptomatic FFF. Also, kinetic results showed improvement in some parameters of gait results after CLO surgery. Thus, our study suggested CLO surgery as an excellent surgical option for symptomatic FFF.

Orthopaedic Simulation of a Morton's Extension to Test the Effect on Plantar Pressures of Each Metatarsal Head in Patients without Deformity: A Pre-Post-Test Study

BACKGROUND

the area beneath the metatarsal heads is a common location of foot pain, which is often associated with high plantar pressures. The aim of this study was to determine the effect of the application of a Morton's extension on the pressure in the metatarsal bones of the foot using a pressure platform.

METHODS

twenty-five subjects without musculoskeletal pathology were selected for this study, and an experiment was conducted with them as the subjects, before and after application of a Morton's extension. The foot regions were divided into the forefoot (transversely subdivided into six areas corresponding to the first, second, third, fourth, and fifth metatarsal heads, and the hallux), midfoot, and rearfoot, and then the maximum and average pressures exerted at each region were measured before and after placing a Morton's extension.

MAIN FINDINGS

we found a pressure reduction, with a p-value less than (p < 0.05), in the head of the second and third metatarsals in statics and dynamics.

CONCLUSIONS

we can conclude that the Morton's extension produces a variation in plantar pressures on the lesser metatarsals. The application of a Morton's extension may be beneficial for the management of forefoot pathology. This study will help clinicians consider various tools to treat forefoot disorders. NCT05879094 (ClinicalTrial.gov (accessed on 18 May 2023)).

Influence of the center of pressure on baropodometric gait pattern variations in the adult population with flatfoot: A case-control study

Background: Adult flatfoot is considered an alteration in the foot bone structure characterized by a decrease or collapse of the medial arch during static or dynamic balance in the gait pattern. The aim of our research was to analyze the center of pressure differences between the population with adult flatfoot and the population with normal feet.

Methods: A case-control study involving 62 subjects was carried out on 31 adults with bilateral flatfoot and 31 healthy controls. The gait pattern analysis data were collected employing a complete portable baropodometric platform with piezoresistive sensors.

Results: Gait pattern analysis showed statistically significant differences in the cases group, revealing lower levels in the left foot loading response of the stance phase in foot contact time (p = 0.016) and contact foot percentage (p = 0.019).

Conclusion: The adult population with bilateral flatfoot evidenced higher contact time data in the total stance phase compared to the control group, which seems to be linked to the presence of foot deformity in the adult population.

The radiographic assessments of spino-pelvic compensation using IoT-based real-time ischial pressure adjustment

In malalignment syndrome, the spino-pelvic alignment correction with foot orthotics can be applied only to a standing position in the coronal plane. Considering the fact that the average time Koreans spend sitting in a chair is 7.5 hours per day, studies on spino-pelvic correction in sitting position is needed. The purpose of this study is to investigate the pressure changes and radiographic assessment of spino-pelvic alignment using a chair equipped with a height-adjustable seat-plate. This study was conducted on 30 participants with spinopelvic malalignment. All participants were subjected to measure buttocks interface pressure while seated using a smart chair in three consecutive steps: 1. on initial seated, 2. on balancing seated, and then. 3. on 1 hour balancing seated. Radiographically, the five spino-pelvic parameters such as shoulder height differences (SHD), iliac crest height differences (ICHD), leg length discrepancy (LLD), pelvic oblique angle (POA), and coronal imbalance were analyzed to investigate the effect of pelvic imbalance compensation on spino-pelvic alignment. Statistical analysis was performed using ANOVA and paired t test. The pressure discrepancy improvement between buttocks from 36.4 ± 32.3 mm on initial seated to 15.7 ± 20.3 mm on balancing, 12.7 ± 10.9 mm on 1hr balancing seated (Ω, P = .008). The radiographic results of pelvic imbalance compensation during seated show a statistical improvement of average SHD (from −0.9 to −0.8 mm, P = .005) and average ICHD (from 9.5 to 2.5 mm, P = .037). For a standing posture after use of smart chair, average SHD value (−3.0 to −1.0 mm, P = .005), ICHD (from 1.8 to 0.8 mm, P = .016), and average LLD value (0.8–0.1 mm, P = .033) were statistically significant improved. Spine-pelvic malalignment can be improved by individually customized pelvic compensation using balanced seat plate height adjustments under the real-time pressure sensing and monitoring on the buttocks while seated.

Effects of corrective insole on leg muscle activation and lower extremity alignment in rice farmers with pronated foot: a preliminary report

BACKGROUND

Execution of strenuous activities in conjunction with slippery and viscous muddy working terrain in rice cultivation leads to a high prevalence of farmer musculoskeletal disorders and malalignments. Recommended intervention strategies originally designed for congenitally disabled individuals may also be applicable to farmers, including simple corrective wedges to reduce foot eversion. The objective of the present study was to conduct a preliminary investigation of the effects of corrective wedges on lower extremity muscle activity and alignment when subjects stood on flat rigid ground or muddy terrain, simulating typical work conditions encountered by the unique but populous Thai rice farming workforce.

METHODS

Nine healthy farmers with pronated feet were recruited to participate and wedges were custom fabricated for each farmer based on physical therapy assessment and use of rapid prototyping techniques. Participants were asked to stand barefoot or with wedges on the two surface types.

RESULTS

Results revealed foot pronation and knee valgus to improve (ranging, on average between 5.5 and 16.1 degrees) when participants were equipped with corrective wedges. The muscle activity of the peroneus longus and the tibialis anterior increased for muddy terrain, as compared with the rigid surface. In general, the wedges induced less tibialis anterior activity and greater peroneus longus activity, compared to when participants were standing barefoot. An elevation in evertor muscle activity may reflect stretching of the shortened muscle as a result of the reduced degree of foot pronation.

CONCLUSIONS

Findings demonstrate potential benefits of corrective insole usage for farmers with pronated feet, including improved lower extremity alignment and invertor muscle activity reduction for both rigid and muddy terrains.

Effectiveness and Reliability of Foot Orthoses on Impact Loading and Lower Limb Kinematics When Running at Preferred and Nonpreferred Speeds

This study examined the effect of foot orthoses used on ground reaction forces, ankle, and knee kinematics when running at preferred and nonpreferred speeds. Sixteen runners ran on instrumented treadmills at various speeds (90%, 100%, and 110% of preferred speed) when wearing arch-support and flat-control orthoses. Two-way repeated analysis of variance (ANOVA) was performed on the mean and coefficient of variation of all variables. Results indicated that arch-support orthoses experienced larger maximum loading rates than flat-control orthoses (P = .017, 95% CI, 2.22 to 19.53). Slower speed was related to smaller loading rates (preferred: P = .002, 95% CI, -17.02 to -4.20; faster: P = .003, 95% CI, -29.78 to -6.17), shorter stride length (preferred: P < .001, 95% CI, -0.204 to -0.090; faster: P < .001, 95% CI, -0.382 to -0.237), and longer contact time (preferred: P < .001, 95% CI, 0.006-0.021; faster: 95% CI, 0.012-0.042). In arch-support condition, preferred speed induced higher stride length coefficient of variation (P = .046, 95% CI, 0.035-1.117) than faster speed, while displaying no differences in flat-control condition. These findings suggest that the use of arch-support orthoses would influence impact loading, but not spatial-temporal and joint kinematics in recreational runners.

An exploratory study investigating the effect of foot type and foot orthoses on gluteus medius muscle activity

Background

Abnormal gluteus medius muscle activity is associated with a number of musculoskeletal conditions. Research investigating the effect of foot type and foot orthoses on gluteus medius muscle activity is both conflicting and limited. The primary aim was to investigate the relationship between foot type and gluteus medius muscle activity during shod walking. The secondary aims of this study were to explore the effect and amount of usage of a pair of unmodified prefabricated foot orthoses on gluteus medius muscle activity during shod walking.

Methods

Foot type was determined using the foot posture index and gluteus medius muscle activity was measured with surface electromyography in 50 healthy adults during shod walking. Participants were then fitted with prefabricated foot orthoses and required to return after 4 weeks. Pearson’s correlation and one-way ANOVA were used to determine effect of foot type. Paired t-tests and ANCOVA were used to determine effect of foot orthoses.

Results

Participants with a cavus foot type demonstrated significantly more gluteus medius mean (p = 0.04) and peak amplitude (p = 0.01), and a greater range in amplitude (p = 0.01) compared to participants with a neutral foot type. Compared to a planus foot type, participants with a cavus foot type demonstrated significantly larger mean (p = 0.02) and peak amplitude (p = 0.01), and a greater range in amplitude (p = 0.01). Prefabricated foot orthoses did not change the gluteus medius muscle activity.

Conclusion

When assessing healthy adults with a cavus foot type, clinicians and researchers should be aware that these participants may display higher levels of gluteus medius muscle activity during gait compared to neutral and planus type feet. Additionally, clinicians and researchers should be aware that the type of prefabricated foot orthoses used did not change gluteus medius muscle activity over 4 weeks. Future research should aim to explore this relationship between foot type and gluteus medius muscle activity in larger sample sizes, consider the potential role of other lower extremity muscles and biomechanical variables, and investigate if these findings also occur in people with pathology.

Effect of different orthotic materials on plantar pressures: a systematic review

Background

The effect of different orthotic materials on plantar pressures has not been systematically investigated. This study aimed to review and summarise the findings from studies that have evaluated the effect of orthotic materials on plantar pressures.

Methods

We conducted a systematic review of experimental studies that evaluated the effect of foot orthotic materials or shoe insole materials on plantar pressures using in-shoe testing during walking. The following databases were searched: MEDLINE, CINAHL, Embase and SPORTDiscus. Included studies were assessed for methodological quality using a modified Quality Index. Peak pressure, pressure-time integral, maximum force, force-time integral, contact area, and contact time were variables of interest. Data were synthesised descriptively as studies were not sufficiently homogeneous to conduct meta-analysis. Standardised mean differences (Cohen’s d) were calculated to provide the size of the effect between materials found in each study.

Results

Five studies were identified as meeting the eligibility criteria. All five studies were laboratory-based and used a repeated measures design. The quality of the studies varied with scores ranging between 20 and 23 on the modified Quality Index (maximum index score 28). The included studies investigated the effects of polyurethane (including PORON®), polyethylene (including Plastazote®), ethyl vinyl acetate (EVA) and carbon graphite on plantar pressures. Polyurethane (including PORON®), polyethylene (including Plastazote®) and EVA were all found to reduce peak pressure.

Conclusion

Based on the limited evidence supplied from the five studies included in this review, some orthotic materials can reduce plantar pressures during walking. Polyurethane (including PORON®), polyethylene (including Plastazote®) and EVA reduce peak pressure beneath varying regions of the foot. Future well-designed studies will strengthen this evidence.

Does the long-term use of medial arch support insole induce the radiographic structural changes for pediatric flexible flat foot? - A prospective comparative study

BACKGROUND

Several conservative treatment methods, from intrinsic muscle exercises to orthoses, including insoles or specially designed shoes, have been introduced for pediatric flexible flat foot (PFFF). However, the structural effects of a long-term use of medial arch support insole remain unclear because the normal physiological maturation of the medial longitudinal arch cannot be ruled out.

METHODS

From January 2005 to June 2015, 18 patients (34 feet) in group 1 (continuously insole applied group) and 13 patients (26 feet) in group 2 (untreated group) were enrolled. Medial arch support insole was applied from the age 10-11years to radiographic physeal closure.

RESULTS

In group 1, talonavicular coverage angle, lateral talo-1st metatarsal angle, calcaneal pitch angle and medial cuneiform height were significantly changed at final follow-up, although all values were still within the abnormal range. Further, no significant differences were found in any of the increments of the radiographic parameters between group 1 and 2.

CONCLUSIONS

Radiographic improvements were found in both of medial arch support insole treated or untreated group despite all radiographic values were still within the abnormal range. It was meaningful that the PFFF could be improved somewhat until the physes were closed. And the hindfoot alignment remained unchanged regardless of medial arch support insole application.

Effect of custom-made and prefabricated foot orthoses on kinematic parameters during an intense prolonged run

Foot orthoses are one of the most used strategies by healthy runners in injury prevention and performance improvement. However, their effect on running kinematics throughout an intense prolonged run in this population is unknown. Moreover, there is some controversy regarding the use of custom-made versus prefabricated foot orthoses. This study analysed the effect of different foot orthoses (custom-made, prefabricated and a control condition) on spatio-temporal and angular (knee flexion and foot eversion) kinematic parameters and their behaviour during an intense prolonged run. Twenty-four recreational runners performed three similar tests that consisted of running 20 min on a treadmill at 80% of their maximal aerobic speed, each one with a different foot orthosis condition. Contact and flight time, and stride length and stride rate were measured every 5 min by an optical measurement photoelectric cell system. Knee flexion and foot eversion kinematic parameters were measured by two high-speed cameras. No significant differences were found between the different foot orthoses in any of the time points studied and between the interaction of foot orthosis and behaviour over time, in any of the variables studied (P > 0.05). The use of custom-made and prefabricated foot orthoses during an intense prolonged run does not produce changes in spatio-temporal and kinematic parameters in healthy runners. These results suggest that a healthy runner maintains its ideal movement pattern throughout a 20 minute prolonged run, regardless the type of foot orthosis used.

The long-term structural effect of orthoses for pediatric flexible flat foot: A systematic review

BACKGROUND

We aimed to evaluate the structural effects of the long-term use of orthoses for pediatric flexible flat foot (PFFF) using an algorithmic approach and a structured critical framework to assess the methodological quality of reported studies.

METHODS

A comprehensive literature search using five databases, namely MEDLINE, the Cochrane Library, Scopus, the Web of Science, and EMBASE, was performed for pertinent articles published before March 30, 2018. Studies with quantitative data on the effects of the long-term use of orthoses for PFFF were included. The search strategy was adapted as appropriate for all other databases searched considering the differences in indexing terms and search syntax for each database.

RESULTS

Randomized controlled trials and prospective cohort studies could not prove the estimated effects of orthoses on the medial longitudinal arch. They revealed that flexible flat feet in young children slowly improved with growth, regardless of the type of footwear used. However, three of four case series studies revealed that positive long-term effects could be achieved using orthoses.

CONCLUSION

There is no strong evidence that the long-term use of orthoses improved the structural problem of PFFF.

A survey of foot orthoses prescription habits amongst podiatrists in the UK, Australia and New Zealand

Background

Foot orthoses are frequently used but little is known about which types are used in contemporary practice. This study aimed to explore the types of foot orthoses currently used by podiatrists and the prescription variations in a range of conditions.

Methods

A web-based, cross-sectional survey was distributed through professional bodies in the United Kingdom (UK), Australia, and New Zealand. Questions focussed on foot orthosis prescription habits in relation to 26 conditions affecting the back and lower limb.

Results

Two hundred and sixty-four podiatrists practising in 19 different countries completed the survey; the majority practised in the UK (47%, n = 124), Australia (30%, n = 79) and New Zealand (12%, n = 32). Respondents qualified between 1968 and 2016, and 147 (56%) were female. Respondents worked in different healthcare sectors and this varied between countries: 42 (34%) respondents in the UK worked solely in the public sector, compared to 3 (4%) in Australia and 2 (6%) in New Zealand. Forty-four (35%) respondents in the UK worked solely in private practice, compared to 64 (81%) in Australia and 14 (44%) in New Zealand.

UK respondents prescribed more prefabricated orthoses per week (mean 5.5 pairs) than simple insole-type devices (±2.7) and customised devices (±2.9). Similarly, respondents in New Zealand prescribed more prefabricated orthoses per week (±7.7) than simple (±1.4) and customised (±2.8) devices. In contrast, those in Australia prescribed more customised orthoses per week (±4.4) than simple (±0.8) and prefabricated (±1.9) orthoses. Differences in the types of orthoses prescribed were observed between country of practice, working sector, and the condition targeted. Generally, prefabricated orthoses were commonly prescribed for the 26 highlighted conditions in the UK and New Zealand. Australian podiatrists prescribed far fewer devices overall, but when they did prescribe, they were more likely to prescribe custom devices. Respondents in all three countries were more likely to prescribe customised orthoses for people with diabetes complicated by peripheral neuropathy than for diabetes without this complication.

Conclusions

Foot orthosis prescription habits vary between countries. Prefabricated orthoses were frequently prescribed in the UK and New Zealand, and customised orthoses in Australia. Prescriptions for people with diabetes differed depending on the presence of neuropathy, despite a lack of robust evidence supporting these decisions. This study provides new insight into contemporary practice.

Electronic supplementary material

The online version of this article (10.1186/s13047-018-0304-z) contains supplementary material, which is available to authorized users.

Pressure Distribution in the Ankle and Subtalar Joint With Routine and Oversized Foot Orthoses

BACKGROUND

Foot orthoses are used to treat many disorders that affect the lower limb. These assistive devices have the potential to alter the forces, load distribution, and orientation within various joints in the foot and ankle. This study attempts to quantify the effects of orthoses on the intra-articular force distribution of the ankle and subtalar joint using a cadaveric testing jig to simulate weight bearing.

METHODS

Five lower-limb cadaveric specimens were placed on a custom jig, where a 334-N (75-lb) load was applied at the femoral head, and the foot was supported against a plate to simulate double-leg stance. Pressure-mapping sensors were inserted into the ankle and subtalar joint. Mean pressure, peak pressure, contact area, and center of force were measured in both the ankle and subtalar joints for barefoot and 2 medial foot orthosis conditions. The 2 orthosis conditions were performed using (1) a 1.5-cm-height wedge to simulate normal orthoses and (2) a 3-cm-height wedge to simulate oversized orthoses.

RESULTS

The contact area experienced in the subtalar joint significantly decreased during 3-cm orthotic posting of the medial arch, but neither orthosis had a significant effect on the spatial mean pressure or peak pressure experienced in either joint.

CONCLUSION

The use of an oversized orthosis could lead to a decrease in the contact area and alterations in the distribution of pressure within the subtalar joint.

CLINICAL RELEVANCE

The use of inappropriate orthoses could negatively impact the force distribution in the lower limb.

Effect of debridement of plantar hyperkeratoses on gait in older people - An exploratory trial

Hyperkeratoses are a common cause of foot pain due to the release of inflammatory mediators, which can have an impact on the mobility and independence of people suffering from them. However, the repercussions that hyperkeratoses have on gait parameters remain uncertain.

AIM

The aim of this study is to analyze the repercussions that plantar hyperkeratosis debridement has on several kinematic and kinetic variables of gait in a group of older participants.

METHODS

98 older participants (75.1 ± 6.7 years) were randomly assigned to two groups: Group A, Scalpel debridement of plantar hyperkeratoses; and Group B, Control group (Simulated debridement). Plantar hyperkeratotic pain was measured before and after treatment on a visual analog scale. Several kinematic and kinetic variables of gait were measured before and after treatment using a Win-Track pressure sensitive walkway.

RESULTS

A significant difference was found in the level of pain between the treated group and the control group (p < 0.01 [8.55-18.15; 95% confidence interval]). Regarding the gait parameters, statistically significant reductions were found in peak pressures (p < 0.05; Cohen's d = 2.688) and maximum force (p < 0.04; d = 0.262).

CONCLUSIONS

Data suggests that debridement of plantar hyperkeratosis may lead to a reduction in pain and appear to reduce peak maximum force and peak plantar pressure. No significant changes were observed in the kinematic variables analyzed. The duration of the benefits remain unknown.

The relationship between foot posture and plantar pressure during walking in adults: A systematic review

BACKGROUND

Foot posture is a risk factor for some lower limb injuries, however the underlying mechanism is not well understood. Plantar pressure analysis is one technique to investigate the interaction between foot posture and biomechanical function of the lower limb.

RESEARCH QUESTION

The aim of this review was to investigate the relationship between foot posture and plantar pressure during walking.

METHODS

A systematic database search was conducted using MEDLINE, CINAHL, SPORTDiscus and Embase to identify studies that have assessed the relationship between foot posture and plantar pressure during walking. Included studies were assessed for methodological quality. Meta-analysis was not conducted due to heterogeneity between studies. Inconsistencies included foot posture classification techniques, gait analysis protocols, selection of plantar pressure parameters and statistical analysis approaches.

RESULTS

Of the 4213 citations identified for title and abstract review, sixteen studies were included and underwent quality assessment; all were of moderate methodological quality. There was some evidence that planus feet display higher peak pressure, pressure-time integral, maximum force, force-time integral and contact area predominantly in the medial arch, central forefoot and hallux, while these variables are lower in the lateral and medial forefoot. In contrast, cavus feet display higher peak pressure and pressure-time integral in the heel and lateral forefoot, while pressure-time integral, maximum force, force-time integral and contact area are lower for the midfoot and hallux. Centre of pressure was more laterally deviated in cavus feet and more medially deviated in planus feet. Overall, effect sizes were moderate, but regression models could only explain a small amount of variance in plantar pressure variables.

SIGNIFICANCE

Despite these significant findings, future research would benefit from greater methodological rigour, particularly in relation to the use of valid foot posture measurement techniques, gait analysis protocols, and standardised approaches for analysis and reporting of plantar pressure variables.

Foot posture is associated with plantar pressure during gait: A comparison of normal, planus and cavus feet

BACKGROUND

Variations in foot posture, such as pes planus (low medial longitudinal arch) or pes cavus (high medial longitudinal arch) are associated with some lower limb injuries. However, the mechanism that links foot posture to injury is not clear. Research question The aim of this study was to compare plantar pressure between healthy individuals with normal, planus or cavus feet.

METHODS

Ninety-two healthy volunteers (aged 18 to 45) were classified as either normal (n = 35), pes planus (n = 31) or pes cavus (n = 26) based on the Foot Posture Index, Arch Index and normalised navicular height truncated. Barefoot walking trials were conducted using an emed^®-x400 plantar pressure system (Novel GmbH, Munich, Germany). An 11 region mask was used that included the medial heel, lateral heel, midfoot, 1st, 2nd, 3rd, 4th and 5th metatarsophalangeal joints, hallux, 2nd toe, and the 3rd, 4th and 5th toes. Peak pressure, pressure-time integral, maximum force, force-time integral and contact area were calculated for each region. One way analyses of variance and effect sizes were used to compare the three foot posture groups.

RESULTS

Overall, the largest differences were between the planus and cavus foot groups in forefoot pressure and force. In particular, peak pressures at the 4th and 5th MTPJs in the planus foot group were lower compared to the normal and cavus foot groups, and displayed the largest effect sizes. Significance This study confirms that foot posture does influence plantar pressures, and that each foot posture classification displays unique plantar pressure characteristics.

Centre of pressure characteristics in normal, planus and cavus feet

Background

The aim of this study was to compare centre of pressure (COP) characteristics between healthy adults with normal, planus or cavus feet who were allocated to groups based on reliable foot posture measurement techniques.

Methods

Ninety-two healthy adult participants (aged 18 to 45) were recruited and classified as either normal (n = 35), pes planus (n = 31) or pes cavus (n = 26) based on Foot Posture Index, Arch Index and normalised navicular height truncated measurements. Barefoot walking trials were conducted using an emed^®-x 400 plantar pressure system (Novel GmbH, Munich, Germany). Average, maximum, minimum and range (difference between maximum and minimum) values were calculated for COP velocity and lateral-medial force index during loading response, midstance, terminal stance and pre-swing phases of stance. The COP excursion index was also calculated. One-way analyses of variance were used to compare the three foot posture groups.

Results

The cavus foot exhibited the slowest average and minimum COP velocity during terminal stance, but this pattern was reversed during pre-swing, when the cavus foot exhibited the fastest maximum COP velocity. The planus foot exhibited the smallest lateral medial force index range during terminal stance. There were no differences between the groups for COP excursion index.

Conclusion

These findings indicate that there are differences in COP characteristics between foot postures, which may represent different mechanisms for generating force to facilitate forward progression of the body during the propulsive phases of gait.

The effect of foot orthoses with forefoot cushioning or metatarsal pad on forefoot peak plantar pressure in running

Background

Foot orthoses are frequently used in sports for the treatment of overuse complaints with sufficient evidence available for certain foot-related overuse pathologies like plantar fasciitis, rheumatoid arthritis and foot pain (e.g., metatarsalgia). One important aim is to reduce plantar pressure under prominent areas like metatarsal heads. For the forefoot region, mainly two common strategies exist: metatarsal pad (MP) and forefoot cushioning (FC). The aim of this study was to evaluate which of these orthosis concepts is superior in reducing plantar pressure in the forefoot during running.

Methods

Twenty-three (13 female, 10 male) asymptomatic runners participated in this cross-sectional experimental trial. Participants ran in a randomised order under the two experimental (MP, FC) conditions and a control (C) condition on a treadmill (2.78 ms⁻¹) for 2 min, respectively. Plantar pressure was measured with the in-shoe plantar pressure measurement device pedar-x®-System and mean peak pressure averaged from ten steps in the forefoot (primary outcome) and total foot was analysed. Insole comfort was measured with the Insole Comfort Index (ICI, sum score 0–100) after each running trial. The primary outcome was tested using the Friedman test (α = 0.05). Secondary outcomes were analysed descriptively (mean ± SD, lower & upper 95%-CI, median and interquartile-range (IQR)).

Results

Peak pressure [kPa] in the forefoot was significantly lower wearing FC (281 ± 80, 95%-CI: 246–315) compared to both C (313 ± 69, 95%-CI: 283–343; p = .003) and MP (315 ± 80, 95%-CI: 280–350; p = .001). No significant difference was found between C and MP (p = .858). Peak pressures under the total foot were: C: 364 ± 82, 95%-CI: 328–399; MP: 357 ± 80, 95%-CI: 326–387; FC: 333 ± 81 95%-CI: 298–368. Median ICI sum scores were: C 50, MP 49, FC 64.

Conclusions

In contrast to the metatarsal pad orthosis, the forefoot cushioning orthosis achieved a significant reduction of peak pressure in the forefoot of recreational runners. Consequently, the use of a prefabricated forefoot cushioning orthosis should be favoured over a prefabricated orthosis with an incorporated metatarsal pad in recreational runners with normal height arches.

Electronic supplementary material

The online version of this article (doi:10.1186/s13047-016-0176-z) contains supplementary material, which is available to authorized users.

Randomized clinical trial into the impact of rigid foot orthoses on balance parameters in excessively pronated feet

Objective: To evaluate the effect of rigid foot orthoses on balance parameters in participants with clinically diagnosed excessively pronated feet.

Design: Randomized clinical trial.

Setting: University biomechanics laboratory.

Participants: Thirty female and 20 male healthy participants (mean 23.89 ± 2.2 years old) with excessively pronated feet, according to a validated foot classification system were randomly assigned to either a control or intervention group.

Interventions: Balance testing was performed using the Balance Performance Monitor with an over-the-counter rigid foot orthoses.

Main outcome measures: Standing balance in the form of mean balance (measures the participants ability to stand with an even load), medial–lateral sway and anterior–posterior sway. All participants were measured while standing bipedally.

Results: There was no significant mean difference in balance scores between the control and intervention group at baseline. After four weeks the results demonstrated no significant differences between mean) balance ( p > 0.05) and anterior–posterior sway ( p > 0.05). However, there was a reduction with the intervention group in medial–lateral sway ( p > 0.02).

Conclusion: The use of foot orthoses in the current study may have improved postural control by stabilizing the rear foot and thus maintaining balance. By the same argument, the benefits of limiting excessive foot pronation may contribute to effective control of internal rotation of the tibia and thereby reduce counter-rotatory motion at the knee and lower leg and maintain balance.

Foot orthoses in the management of chronic subtalar and talo crural joint pain in rheumatoid arthritis

BACKGROUND

This pilot study investigated whether semi-rigid and soft orthoses had an effect on pain, disability and functional limitation in participants with chronic rheumatoid hindfoot involvement.

METHODS

Participants with chronic hindfoot pain were randomly assigned to 2 groups, commencing either with semi-rigid Subortholene orthoses or soft EVA orthoses. The Foot Function Index and the Ritchie Articular Index were administered pre- and post-intervention, which lasted for 3 months. Following a 2 week washout period, each group was switched over to the other type of orthoses.

RESULTS

Nine female participants (mean age 52.2years (SD 9.1); mean weight 71kg (SD 12.64); mean height 160cm (SD 5.18)) with a mean RA duration of 11.7years (SD 7.83), and a mean ankle/subtalar joint pain duration of 5.7years (SD 2.62), completed the programme. Mean improvement in FFI score for both orthoses resulted in the same statistical significance (p=0.001). Statistically significant reduction in pain, disability and functional limitation was observed for both interventions, together with improvement in the Ritchie Articular Index score.

CONCLUSION

Both Subortholene and EVA orthoses significantly reduced pain, disability and functional limitations in participants with chronic ankle/subtalar joint pain in rheumatoid arthritis.

The effects of biomechanical foot orthoses on the gait patterns of patients with malalignment syndrome as determined by three dimensional gait analysis

[Purpose] The biomechanical effects of foot orthoses on malalignment syndrome have not been fully clarified. This experimental investigation was conducted to evaluate the effects of orthoses on the gait patterns of patients with malalignment syndrome. [Subjects and Methods] Ten patients with malalignment syndrome were recruited. For each participant, kinematic and kinetic data were collected under three test conditions: walking barefoot, walking with flat insoles in shoes, and walking with a biomechanical foot orthosis (BFO) in shoes. Gait patterns were analyzed using a motion analysis system. [Results] Spatiotemporal data showed the step and stride lengths when wearing shoes with flat insoles or BFO were significantly greater than when barefoot, and that the walking speed when wearing shoes with BFO was significantly faster than when walking barefoot or with shoes with flat insoles. Kinetic data, showed peak pelvic tilt and obliquity angle were significantly greater when wearing BFO in shoes than when barefoot, and that peak hip flexion/extension angle and peak knee flexion/extension and rotation angles were significantly greater when wearing BFO and flat insoles in shoes than when barefoot. [Conclusion] BFOs can correct pelvic asymmetry while walking.

'Trial and error…', '…happy patients' and '…an old toy in the cupboard': a qualitative investigation of factors that influence practitioners in their prescription of foot orthoses

Background

Foot orthoses are used to manage of a plethora of lower limb conditions. However, whilst the theoretical foundations might be relatively consistent, actual practices and therefore the experience of patients is likely to be less so. The factors that affect the prescription decisions that practitioners make about individual patients is unknown and hence the way in which clinical experience interacts with knowledge from training is not understood. Further, other influences on orthotic practice may include the adoption (or not) of technology. Hence the aim of this study was to explore, for the first time, the influences on orthotic practice.

Methods

A qualitative approach was adopted utilising two focus groups (16 consenting participants in total; 15 podiatrists and 1 orthotist) in order to collect the data. An opening question “What factors influence your orthotic practice?” was followed with trigger questions, which were used to maintain focus. The dialogue was recorded digitally, transcribed verbatim and a thematic framework was used to analyse the data.

Results

There were five themes: (i) influences on current practice, (ii) components of current practice, (iii) barriers to technology being used in clinical practice, (iv) how technology could enhance foot orthoses prescription and measurement of outcomes, and (v) how technology could provide information for practitioners and patients. A final global theme was agreed by the researchers and the participants: ‘Current orthotic practice is variable and does not embrace technology as it is perceived as being not fit for purpose in the clinical environment. However, practitioners do have a desire for technology that is usable and enhances patient focussed assessment, the interventions, the clinical outcomes and the patient’s engagement throughout these processes’.

Conclusions

In relation to prescribing foot orthoses, practice varies considerably due to multiple influences. Measurement of outcomes from orthotic practice is a priority but there are no current norms for achieving this. There have been attempts by practitioners to integrate technology into their practice, but with largely negative experiences. The process of technology development needs to improve and have a more practice, rather than technology focus.

A study of the immediate effects of glycerine-filled insoles, contoured prefabricated orthoses and flat insoles on single-leg balance, gait patterns and perceived comfort in healthy adults

Background

Footwear interventions are often prescribed to assist with the management of lower limb pain, injury and disease. Commercially available shoe insoles and orthoses are increasingly incorporating novel design features to alleviate foot and lower limb symptoms, but this may be at a cost to optimal functional performance. This study compared the immediate effects of wearing glycerine-filled insoles, contoured prefabricated orthoses, and flat insoles, on balance and gait measures.

Methods

Thirty healthy adults (17 men, 13 women; mean [SD] age: 24.3 [2.5] years) performed tests of single-leg standing with eyes open (Kistler force platform), star excursion balance test, and level-ground walking (GAITRite® walkway system), under three randomised conditions: wearing glycerine-filled insoles, prefabricated orthoses, and flat (control) insoles, within their own footwear. Centre of pressure movement (anterior-posterior and mediolateral range and standard deviation, total path velocity), star excursion balance test reach distance, and temporospatial gait variables were collected. Perceived comfort of the inserts was scored immediately after use on a 100 mm visual analogue rating scale. After trialling all inserts each participant ranked their level of comfort from least to most.

Results

Centre of pressure measures, star excursion balance test reach distance, or temporospatial gait variables did not differ between the three inserts (all P values >0.088). Significant between-condition differences were reported for comfort ranking (P = 0.031), but not rating scores (P = 0.638). Weak to moderate negative correlations (r values ranged between −0.368 and −0.406) were observed between visual analogue scale comfort rating for the flat insoles and prefabricated orthoses, star excursion balance test and gait measures.

Conclusions

Single-leg standing balance, star excursion balance test performance, and level-ground walking patterns in asymptomatic adults do not appear to differ when wearing glycerine-filled insoles, contoured prefabricated orthoses, or flat insoles. Perceived comfort may be related to the biomechanical or clinical effectiveness of novel footwear interventions, and requires further investigation. Importantly, these findings are specific to a healthy population and further research is needed to determine the long-term effects of glycerine-filled insoles in patients with known balance impairments.

The influence of foot orthoses on foot mobility magnitude and arch height index in adults with flexible flat feet

BACKGROUND

Flexible flat foot is described as a reduction in the height of the medial longitudinal arch and may occur from abnormal foot pronation. A foot orthosis is thought to modify and control excessive pronation and improve arch height.

OBJECTIVE

To compare the immediate effect of three types of orthoses on foot mobility and the arch height index in subjects with flexible flat feet.

STUDY DESIGN

A quasi-experimental study.

METHOD

The dorsal arch height, midfoot width, foot mobility and arch height index were assessed in 20 participants with flexible flat feet (mean age = 23.2 ± 3 years) for three different foot orthosis conditions: soft, semi-rigid and rigid University of California Biomechanics Laboratory (UCBL).

RESULTS

Maximum midfoot width at 90% with arch mobility in the coronal plane was shown in the semi-rigid orthosis condition. The semi-rigid orthosis resulted in the highest mean foot mobility in 90% of weight bearing, and the rigid orthosis (UCBL) had the lowest mean foot mobility. The soft orthosis resulted in foot mobility between that of the rigid and the semi-rigid orthosis. UCBL orthosis showed the highest arch height index, and the semi-rigid orthosis showed the lowest mean arch height index.

CONCLUSION

Due to its rigid structure and long medial-lateral walls, the UCBL orthosis appears to limit foot mobility. Therefore, it is necessary to make an orthosis that facilitates foot mobility in the normal range of the foot arch. Future studies should address the dynamic mobility of the foot with using various types of foot orthoses.

CLINICAL RELEVANCE

Although there are many studies focussed on flat foot and the use of foot orthoses, the mechanism of action is still unclear. This study explored foot mobility and the influence of foot orthoses and showed that a more rigid foot orthosis should be selected based on foot mobility.

Footwear interventions: a review of their sensorimotor and mechanical effects on balance performance and gait in older adults

Footwear interventions, including shoe insoles and foot orthoses, have the capacity to enhance balance control and gait in older people. This review assessed the evidence for the effect of footwear interventions on static and dynamic balance performance and gait in older populations and explored proposed theories for underlying sensorimotor and mechanical mechanisms. We searched the Medline, EMBASE, CINAHL (the Cumulative Index to Nursing and Allied Health Literature), and AMED databases and conducted hand searches. Of 115 relevant articles screened, 14 met the predefined inclusion criteria. Articles were grouped into one of three categories based on balance task (static balance performance during quiet standing, dynamic balance performance during walking, and dynamic balance performance during perturbed standing or functional tasks) and were scored for methodological quality using the Downs and Black Quality Index tool. Footwear interventions seem to alter underlying strategies controlling static and dynamic movement patterns through a combination of sensorimotor and mechanical mechanisms in older people, including those with chronic sensory and musculoskeletal conditions. Evidence shows a consistent trend toward footwear interventions markedly improving lateral stability measures, which are predictors of falls in the elderly. In-depth investigation of neurophysiologic responses to footwear interventions is necessary to help confirm any sensorimotor adaptations. The long-term effects of footwear interventions on balance, gait, and the prevention of falls in older people require further investigation.

Evaluating a standardised tool to explore the nature and extent of foot and ankle injuries in amateur and semi-professional footballers

BACKGROUND

Most studies of football injuries include professional players and data have been collected in without a single validated, standardised tool. We aimed to develop a new standardised questionnaire for assessing injuries among non-professional footballers and pilot its use.

METHOD

A questionnaire was developed using input from footballers, healthcare professionals and triangulation from the literature. The new tool was piloted among players representing amateurs and semi-professionals. Their comments were used iteratively to improve the instrument.

RESULTS

The development phase produced a 33-item questionnaire collecting quantitative and qualitative data. In the pilot phase, 42 questionnaires were distributed, 34 (81%) returned. Respondents reported total of 273 football-related injuries, 114 affecting the foot/ankle (70 at the ankle and 44 at the foot). In total, 44% of respondents had suffered one or more foot/ankle injuries in the past 12 months.

CONCLUSION

We developed a new standardised tool which we found to be well-completed by young male footballers in semi-professional and amateur settings with an excellent response rate. Our results suggested that foot/ankle injuries were common, larger studies in non-professionals are needed to identify risk factors for injury and develop pragmatic advice for prevention.

Consensus-based recommendations of Australian podiatrists for the prescription of foot orthoses for symptomatic flexible pes planus in adults

BACKGROUND

Foot orthoses are commonly used for symptomatic flexible pes planus in adults. However, there are no clinical guidelines for the prescription of customised foot orthoses that are specific to this population. The aim of this study was to investigate prescription habits of Australian podiatrists for customised foot orthoses for symptomatic flexible pes planus in adults and to develop consensus-based practice recommendations for the prescription of these foot orthoses.

METHODS

A four round Delphi survey was undertaken with 24 podiatric experts to establish current use and rationale for individual prescription variables of customised foot orthoses for symptomatic flexible pes planus in adults. Round one determined prescription use (consensus) and rounds two, three and four determined the rationale for use (agreement) of prescription variables across the rearfoot, midfoot, forefoot, as well as accommodation and materials used. For consensus and agreement to be accepted, 70% of the respondents were required to use or agree on the rationale for use of individual prescription variables.

RESULTS

Consensus was reached in round one for two variables, choice of shell material (polyolefin) and when to prescribe a forefoot post balanced to perpendicular. In rounds two, three and four, agreement was reached for 52 statements related to the rationale for use of individual prescription variables, including when to prescribe: an inverted cast pour [heel in an inverted position], an inverted rearfoot post, a medial heel (Kirby) skive, minimal/maximum arch fill, a medial flange, a forefoot post and common orthotic accommodations.

CONCLUSION

This study found consensus or agreement for the use of several prescription variables for customised foot orthoses for symptomatic flexible pes planus in adults. The findings were used to develop the Foot orthosis Prescription Recommendations for symptOmatic flexible Pes planus in adults (FootPROP) proforma, to guide clinicians and researchers in the prescription of customised foot orthoses for this population.

Effects of off-the-shelf foot orthoses on plantar foot pressures in patients with early rheumatoid arthritis

BACKGROUND

Rheumatoid arthritis (RA) often affects feet with progressive pathologic changes to foot morphology and pressure distribution. Studies in RA suggest that reductions in forefoot peak pressures can reduce pain. We investigated the effects of off-the-shelf foot orthoses on plantar foot pressures in patients with early RA.

METHODS

Thirty-five patients with early RA were recorded walking. Variables measured were forefoot peak plantar pressure (PPPft), forefoot pressure-time integral (PTIft), and hallux and lesser toe and midfoot contact areas. Patients were analyzed while walking barefoot, with shoes, and with shoes and foot orthoses. Measurements were taken at baseline and at 3 and 6 months.

RESULTS

There were significantly increased PPPft values between barefoot and shod and between barefoot and orthoses (P < .01). However, there was a significant reduction in PPPft during the 6 months with orthoses compared with shoes only (P < .01). Foot orthoses significantly reduced PTIft over 6 months (P < .01). Results also demonstrated a significant increase in hallux and lesser toe (P < .01) and midfoot (P < .01) contact areas during the 6 months with foot orthoses.

CONCLUSIONS

In patients with early RA, off-the-shelf foot orthoses cause a significant reduction of 22% in PPPft and 14% in PTIft as soon as insoles are worn compared with shod. Further reductions for orthoses compared with baseline were found by 3 months (15% in PPPft and 14% in PTIft) and 6 months (33% in PPPft and 33% in PTIft). These findings could contribute to reductions in foot pain.

Influence of foot orthosis customisation on perceived comfort during running

Although running is associated with many health benefits, it also exposes the body to greater risk of injury. Foot orthoses are an effective strategy to prevent such injuries. Comfort is an essential element in orthosis design since any discomfort alters the runner's biomechanics, compromising performance and increasing the risk of injury. The present study analyses the perceived comfort of three types of orthoses: custom-made, prefabricated and original running shoe insoles. Nine comfort variables for each insole were assessed in a sample of 40 runners. Custom-made and prefabricated insoles were both perceived as significantly more comfortable than the original insoles. The differences were clinically relevant and were potentially causes of modifications in running gait. Although the prefabricated insoles were rated slightly higher than the custom-made insoles, the differences were not statistically significant. This study shows that prefabricated insoles constitute a reasonable alternative to custom-made insoles in terms of comfort.

PRACTITIONER SUMMARY

The perceived level of comfort of footwear is considered to be a protective measure of the potential risk of running injuries. We here compared runners' perception of comfort of custom-made and prefabricated orthoses while running. We found that even though custom-made orthoses are closely matched to each individual's foot, such customisation does not necessarily imply greater comfort.

The evaluation of modified foot orthosis on muscle activity and kinetic in a subject with flexible flat foot : single case study

BACKGROUND

Due to blocking of pronation/dorsiflexion in flexible flat foot and restriction of these movements in using the University of California Berkeley Laboratory orthosis, provided pressures in sole by the orthosis were increased. Therefore, this article describes the evaluation of modified foot orthosis with flexible structure in the management of individuals with flexible flat foot. CASE DESCRIPTION AND METHOD: The patient was a 21-year-old male who had symptomatic flat foot. The modified foot orthosis included movable surface and the outside structure. The modified foot orthosis was evaluated by standing foot X-ray, comfort rate, electromyography of leg muscle and vertical ground reaction force during walking.

FINDINGS AND OUTCOMES

The modified foot orthosis improved the foot alignment and decreased the symptoms of flat foot with more comfort. Subtalar position by sub-maximum supination had higher position than neutral in sagittal plane. It may increase the muscle activity of peroneus longus by 7% compared to barefoot, and there was a decrease of 11% ground reaction force in mid stance.

CONCLUSION

The result of this single case evaluation only proposed the feasibility of this modified insole as the orthotic treatment in flexible flat foot. Clinical relevance The modified foot orthosis, which is mobile in the midfoot, is an orthosis for walking and standing in subjects with flexible flat foot.

Mechanism of orthotic therapy for the painful cavus foot deformity

BACKGROUND

People who have extremely high arched feet or pes cavus often suffer from substantial foot pain. Custom-made foot orthoses (CFO) have been shown to be an effective treatment option, but their specificity is unclear. It is generally thought that one of the primary functions of CFO is redistributing abnormal plantar pressures. This study sought to identify variables associated with pain relief after CFO intervention.

METHODS

Plantar pressure data from a randomized controlled trial of 154 participants with painful pes cavus were retrospectively re-analyzed at baseline and three month post CFO intervention. The participants were randomized to a treatment group given CFO or a control group given sham orthoses.

RESULTS

No relationship between change in pressure magnitude and change in symptoms was found in either group. However, redistribution of plantar pressure, measured with the Dynamic Plantar Loading Index, had a significant effect on pain relief (p = 0.001). Our final model predicted 73% of the variance in pain relief from CFO and consisted of initial pain level, BMI, foot alignment, and changes in both Dynamic Plantar Loading Index and pressure-time integral.

CONCLUSION

Our data suggest that a primary function of effective orthotic therapy with CFO is redistribution of abnormal plantar pressures. Results of this study add to the growing body of literature providing mechanistic support for CFO providing pain relief in painful foot conditions. The proposed model may assist in better designing and assessing orthotic therapy for pain relief in patients suffering painful cavus foot deformity.

TRIAL REGISTRATION

Randomized controlled trial: ISRCTN84913516.

Association of navicular drop and selected lower-limb biomechanical measures during the stance phase of running

There is evidence to suggest that navicular drop measures are associated with specific lower-extremity gait biomechanical parameters. The aim of this study was to examine the relationship between navicular drop and a) rearfoot eversion excursion, b) tibial internal rotation excursion, c) peak ankle inversion moment, and d) peak knee adduction moment during the stance phase of running. Sixteen able-bodied men having an average age of 28.1 (SD=5.30) years, weight of 81.5 (SD=10.40) kg, height of 179.1 (SD=5.42) cm volunteered and ran barefoot at 170 steps/minute over a force plate. Navicular drop measures were negatively correlated with tibial internal rotation excursion (r=-0.53, P=.01) but not with rearfoot eversion excursion (r=-0.19; P=.23). Significant positive correlations were found between navicular drop and peak knee adduction moment (r=.62, P<.01) and peak ankle inversion moment (r=.60, P<.01). These findings suggest that a low navicular drop measure could be associated with increasing tibial rotation excursion while high navicular drop measure could be associated with increased peak ankle and knee joint moments. These findings indicate that measures of navicular drop explained between 28% and 38% of the variability for measures of tibial internal rotation excursion, peak knee adduction moment and peak ankle inversion moments.

Assessment of gait characteristics and orthotic management in children with Developmental Coordination Disorder: preliminary findings to inform multidisciplinary care

Developmental Coordination Disorder (DCD) is a neurodevelopmental disorder characterised by impaired motor co-ordination and awkward gait. Despite self-reported findings of pes planus and joint hypermobility in children with DCD, there is little objective evidence regarding the clinical management of the foot in children with DCD. The aims of this research were to report clinical findings of foot posture and lower limb hypermobility in children with DCD and to evaluate the impact of foot orthoses on spatio-temporal gait parameters. Children with DCD were recruited into the study. Participants were randomly assigned to an intervention group who received foot orthoses at the start of their rehabilitation programme or to a second group who received foot orthoses at the end of their intervention programme. Foot posture was assessed with the Foot Posture Index and lower limb hypermobility assessed with the Lower Limb Assessment Score. The effect of foot orthoses was evaluated through assessment of spatio-temporal gait characteristics at baseline and post-rehabilitation programme. Fourteen children were recruited (mdn age 7.5 years) with nine children assigned to the group receiving orthoses early (mdn age 8 years) and five children assigned to the post-rehabilitation orthoses group (mdn age 6.5 years). A pes planus foot posture (FPI score=8) and lower limb hypermobility (LLAS score=11) were observed. Changes in spatio-temporal gait parameters failed to reach significance (p>.012) following orthotic invention but demonstrated a trend towards a decreased cadence and increased double support duration. Despite non-significant findings this work offers preliminary support for podiatric intervention in the rehabilitation of children with DCD. Further work is required to understand the biomechanics of gait in children with DCD and appreciate the role of podiatry as a component of multidisciplinary care.

The effect of prefabricated and proprioceptive foot orthoses on plantar pressure distribution in patients with flexible flatfoot during walking

BACKGROUND

Previous studies have suggested that orthoses with different constructions could alter gait parameters in flexible flatfoot. However, there is less evidence about the effect of insoles with proprioceptive mechanism on plantar pressure distribution in flatfoot.

OBJECTIVES

To assess the effect of orthoses with different mechanisms on plantar pressure distribution in subjects with flexible flatfoot.

STUDY DESIGN

Quasi-experimental.

METHODS

In total, 12 flatfoot subjects were recruited for this study. In-shoe plantar pressure in walking was measured by Pedar-X system under three conditions including wearing the shoe only, wearing the shoe with a proprioceptive insole, and wearing the shoe with a prefabricated foot insole.

RESULTS

Using the proprioceptive insoles, maximum force was significantly reduced in medial midfoot, and plantar pressure was significantly increased in the second and third rays (0.94 ± 0.77 N/kg, 102.04 ± 28.23 kPa) compared to the shoe only condition (1.12 ± 0.88 N/kg and 109.79 ± 29.75 kPa). For the prefabricated insole, maximum force was significantly higher in midfoot area compared to the other conditions (p < 0.05).

CONCLUSIONS

Construction of orthoses could have an effect on plantar pressure distribution in flatfeet. It might be considered that insoles with sensory stimulation alters sensory feedback of plantar surface of foot and may lead to change in plantar pressure in the flexible flatfoot.

CLINICAL RELEVANCE

Based on the findings of this study, using orthoses with different mechanisms such as proprioceptive intervention might be a useful method in orthotic treatment. Assessing plantar pressure can also be an efficient quantitative outcome measure for clinicians in evidence-based foot orthosis prescription.

ANALYSIS OF PEAK PRESSURE, MAXIMAL FORCE, AND CONTACT AREA CHANGES DURING WALKING AND RUNNING WITH CONVENTIONAL AND SHOCK-ABSORBING INSOLES IN THE COMBAT BOOTS OF THE CZECH ARMY

The aim of this study was to determine changes of peak pressure, maximal force, and contact area in five foot regions with two different insoles during walking and running, thereby obtaining data contributing to optimization of footwear and reduction of lower leg injury.

Twenty-six male soldiers participated in the study. Peak pressure, maximal force, and contact area were measured in five foot regions (lateral and medial heel, midfoot, lateral and medial forefoot, big toe, and toes 2, 3, 4, and 5) with two different insoles (conventional vs. custom molded shock-absorbing insoles) during a walking speed of 5 km/h and running speeds of 8 and 12 km/h using the Pedar-X tensometric system (Novel, St. Paul, MN). Measurements revealed that the shock-absorbing insoles significantly (p < 0.05) attenuated the peak pressures in heel and forefoot region and increased the contact area in the midfoot region which indicates a successful redistribution of forces that arise during the contact phase in walking and running. Shock-absorbing insoles hence may contribute to better plantar pressure distribution during walking and running, and effectively prevent lower leg injuries.

[Treatment of pediatric flat feet by shoe insoles : a scientific-based therapy?]

The differentiation of physiological pediatric flat feet and the pathological course as well as adequate initiation of therapeutic options represents a challenge the importance of which should not be underestimated. Fears and worries of parents and their insistence on inducement of therapeutic measures take center stage in the physician-patient relationship. The problem is that there are insufficient data from scientific studies dealing with the conservative treatment of flat feet in children. This paper intends to give a survey of the current status in the literature concerning indications and therapeutic success using insoles in the treatment of flat feet in children.

Evaluation of combined prescription of rocker sole shoes and custom-made foot orthoses for the treatment of plantar fasciitis

BACKGROUND

It is a routine practice to prescribe a combination of rocker shoes and custom-made foot orthoses for patients with plantar fasciitis. Recently, there has been a debate on this practice, and studies have shown that the individual prescription of rocker shoes or custom-made foot orthoses is effective in treating plantar fasciitis. The aim of this study was to evaluate and compare the immediate therapeutic effects of individually prescribed rocker sole shoes and custom-made foot orthoses, and a combined prescription of them on plantar fasciitis.

METHODS

This was a cross-over study. Fifteen patients with unilateral plantar fasciitis were recruited; they were from both genders and aged between 40 and 65. Subjects performed walking trials which consisted of one 'unshod' condition and four 'shod' conditions while wearing baseline shoes, rocker shoes, baseline shoes with foot orthotics, and rocker shoes with foot orthotics. The study outcome measures were the immediate heel pain intensity levels as reflected by visual analog scale pain ratings and the corresponding dynamic plantar pressure redistribution patterns as evaluated by a pressure insole system.

RESULTS

The results showed that a combination of rocker shoes and foot orthoses produced a significantly lower visual analog scale pain score (9.7 mm) than rocker shoes (30.9 mm) and foot orthoses (29.5 mm). With regard to baseline shoes, it also significantly reduced the greatest amount of medial heel peak pressure (-33.58%) without overloading other plantar regions when compared to rocker shoes (-7.99%) and foot orthoses (-28.82%).

DISCUSSION

The findings indicate that a combined prescription of rocker sole shoes and custom-made foot orthoses had greater immediate therapeutic effects compared to when each treatment had been individually prescribed.

Effects of foot orthoses: How important is the practitioner?

Foot orthoses (FO) are commonly used in the treatment of numerous lower limb problems, pains and injuries. Whilst many studies report their positive effects, and most practitioners would confirm those findings, the available information appears to be anecdotal. As such, the exact mechanisms in which FO work are not fully understood. Therefore, a need exists to study the influence of the inter-practitioner variability in the assessment of orthoses performance. This investigation is central to the understanding of the performance variations in custom-made foot orthoses (CFO). Eleven practitioners took part in the study. Each practitioner completed a clinical assessment of one subject, after which a pair of foot orthoses was manufactured based on casts of the subject's feet using a neutral non-weight bearing plaster cast. Ten trials per condition were recorded during which kinematic and kinetic data were collected. CFO did not have any systematic significant effects (p<0.05) on any kinetic except for the right-leg peak active force. In addition, systematic kinematic effects could be observed mainly for the sagittal plane for forefoot-to-hindfoot and hindfoot-to-tibia peak angles. The results from this study demonstrate that inter-practitioner variability is a major factor in orthotic intervention in treating a single patient and for a specific pathology. It is therefore strongly recommended to use caution when drawing general conclusions from research studies using custommade foot orthoses. The results suggest that CFO effects can differ between limbs. More importantly, their effects are also practitioner-dependant. Great caution should be used when comparing studies on CFO with different practitioners as conclusions could vastly differ.

Foot orthoses: a review focusing on kinematics

Orthoses have been broadly used by clinicians to treat mechanical misalignments, such as abnormal foot pronation. As such, the influences of orthoses on lower-limb kinematics have been studied numerous times, with many articles reporting nonsystematic results; the aim of this review, therefore, was to examine the recognized effects of foot orthoses on lower-limb kinematics. The findings from this review suggest that foot orthoses seem to have certain generic and common effects on the lower limb when designed to control rearfoot pronation. We also discuss the possible reasons behind the lack of consistent results between studies. Based on the findings, a list of recommendations is presented for future research on foot orthoses to facilitate comparisons between studies and enable the scientific and clinical communities to better comprehend the effects that these variables might have on the kinematics and, possibly, the treatment outcomes.

Predictors of adherence to a multifaceted podiatry intervention for the prevention of falls in older people

Background

Despite emerging evidence that foot problems and inappropriate footwear increase the risk of falls, there is little evidence as to whether foot-related intervention strategies can be successfully implemented. The aim of this study was to evaluate adherence rates, barriers to adherence, and the predictors of adherence to a multifaceted podiatry intervention for the prevention of falls in older people.

Methods

The intervention group (n = 153, mean age 74.2 years) of a randomised trial that investigated the effectiveness of a multifaceted podiatry intervention to prevent falls was assessed for adherence to the three components of the intervention: (i) foot orthoses, (ii) footwear advice and footwear cost subsidy, and (iii) a home-based foot and ankle exercise program. Adherence to each component and the barriers to adherence were documented, and separate discriminant function analyses were undertaken to identify factors that were significantly and independently associated with adherence to the three intervention components.

Results

Adherence to the three components of the intervention was as follows: foot orthoses (69%), footwear (54%) and home-based exercise (72%). Discriminant function analyses identified that being younger was the best predictor of orthoses use, higher physical health status and lower fear of falling were independent predictors of footwear adherence, and higher physical health status was the best predictor of exercise adherence. The predictive accuracy of these models was only modest, with 62 to 71% of participants correctly classified.

Conclusions

Adherence to a multifaceted podiatry intervention in this trial ranged from 54 to 72%. People with better physical health, less fear of falling and a younger age exhibited greater adherence, suggesting that strategies need to be developed to enhance adherence in frailer older people who are most at risk of falling.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12608000065392.

Chiropractic adjustments and orthotics reduced symptoms for standing workers

OBJECTIVE

This controlled study was designed to explore the effectiveness of foot orthotics in solving problems of the feet and other parts of the lower extremities and to reduce low back pain.

METHODS

Thirty-two subjects (24 males) were recruited and randomly assigned into 3 study groups. There were 10 subjects in the chiropractic care plus orthotics group, 14 subjects in the orthotics group, and 8 in the control group. All subjects filled out a patient information sheet and pre-screening foot pain questionnaire. Foot orthotics information was collected and the data was sent to Foot Level-ers, Inc. for orthotic fabrication. Chiropractic treatment was performed using Activator Technique. In-home exercise was prescribed to subjects receiving orthotics and chiropractic care.

RESULTS

The control group did not experience much change during the testing period. The orthotics group showed improvement in symptoms (P = 0.053), activities of daily living (P = 0.058), sport and recreation (P = 0.186) and quality of life (P = 0.085). While trends were apparent, the improvements did not reach statistically significant levels. In contrast, there was no trend with pain (P = 0.492). The orthotics plus chiropractic group showed improvement in the four conditions over the study period. Greater improvement was seen in quality of life (P < 0.05), symptoms (P < 0.05) and activities of daily living (P < 0.05), which were statistically significant. Improvement was also seen in sports and recreation but it did not reach statistical significant level (P = 0.097).

CONCLUSION

This study showed that a combination of chiropractic care and orthotics improved symptoms, activities of daily living, sport and recreation and quality of life in workers whose job requires them to stand at least 6 hours daily.